Staphylococcus aureus r r r r r r Key words Staphylococcus aureus β S. aureus
I Staphylococcus aureus μ β β II S. aureus β
4, culture (except blood) blood culture bed days Total number of culture samples 3, 2, 1, 4,643 5,735 26,718 24,974 419,61 366,797 6,541 22,758 38,849 7,59 8,2 8,434 21,16 2,831 2,688 365,885 37,252 364,946 9,871 21,662 45,582 1,266 22,795 49,114 45, 4, Total number of inpatient bed days/fiscal year 35, Fig. 1. Total number of culture samples and inpatient bed days. The white columns represent the total number of bacterial culture samples (excluding blood culture samples) in each fiscal year, and the spotted columns represent the total number of blood culture samples in each fiscal year. The line graph represents the number of inpatient bed days for each fiscal year. All data were collated for April to March on a fiscal year basis. r r r r r rr r r r r rr r r r r r rrrr III S. aureus meca S. aureus
(1) All Samples 2, 43.5% 43.9% 38.8% 4.4% 36.3% 36.2% Number of isolates of MRSA, MSSA in Staphylococcus aureus 1,5 1, 5 32.2% 31.9% 1,568 1,497 1,311 1,372 1,312 1,433 1,322 1,258 682 581 576 554 476 519 426 41 (2) Samples of Blood Culture 16 6.6% 6.4% 59.8% Number of isolates of MRSA, MSSA in Staphylococcus aureus 12 8 4 99 96 6 58 132 51.1% 51.7% 137 79 7 62 43.8% 38.3% 4.6% 46 44 41 12 15 115 11 5% 4% 3% 2% 1% % 7% 6% 5% 4% 3% 2% 1% % % of MRSA in Staphylococcus aureus % of MRSA in Staphylococcus aureus MSSA MRSA MRSA isolation rate MSSA MRSA MRSA isolation rate Fig. 2. Number of methicillin-resistant and methicillin-susceptible Staphylococcus aureus isolates and the isolation rate of methicillin-resistant Staphylococcus aureus. (1) All the bacterial culture samples (blood, sputum, pus, urine, and stool): The spotted columns represent the number of methicillin-resistant Staphylococcus aureus (MRSA) isolates among the SA isolates in all the samples. The white columns represent the number of methicillin-susceptible Staphylococcus aureus (MSSA) isolates among the SA isolates in all the samples. The line graph represents the isolation rates of MRSA (%) among the SA isolates in all the samples. (2) Blood culture samples: The shaded columns represent the number of MRSA isolates among the SA isolates in the blood culture samples. The white columns represent the number of MSSA isolates among the SA isolates in the blood culture samples. The line graph represents the MRSA isolation rates (%) among the SA isolates in the blood culture samples. μ β
Total number of patients with newly isolated MRSA/fiscal year 7 6 5 4 3 2 1 572 473 47 436 322 38 242 26 Fig. 3. Total number of patients per month with newly identified methicillin-resistant Staphylococcus aureus cultures. The monthly number of patients with a newly identified MRSA culture was added together to obtain the total number for each fiscal year. 25 Total amount of antimicrobials (DDDs/1 bed days) 2 15 1 5 Carbapenems Oxacephems 4th-generation cephalosporins 3rd-generation cephalosporins 2nd-generation cephalosporins 1st-generation cephalosporins Penicillins Fig. 4. Antimicrobial usage density: -lactam antibiotics. The AUD of -lactam antibiotics per 1 bed days was calculated on a fiscal year basis.
2 Ciprofloxacin Pazufloxacin Vancomycin Teicoplanin Total amount of antimicrobials (DDDs/1 bed days) 1.5 1.5 Fig. 5. Antimicrobial usage densities: fluoroquinolones and glycopeptides. The AUD of fluoroquinolones and glycopeptide antibiotics per 1 inpatient bed days was calculated on a fiscal year basis. % of AUD (Antimicrobial usage density) 1% 8% 6% 4% 2% TAZ/PIPC PIPC SBT/ABPC PCG 1% % % Penicillins Carbapenems 1% 1% 8% 6% 4% SBT/SPZ CTX CTRX CAZ 8% 6% 4% 2% 2% % % 24 25 26 27 28 29 21211 24 25 26 27 28 29 21211 3rd-generation Cephalosporins 4th-generation Cephalosporins 8% 6% 4% 2% DRPM BIPM PAPM/BP IPM/CS MEPM CZOP CFPM CPR Fig. 6. Rate of antimicrobial usage densities: penicillins, 3rd-generation cephalosporins, 4th-generation cephalosporins and carbapenems. The rate (%) of AUD for penicillins, 3rd-generation cephalosporins, 4th-generation cephalosporins and carbapenems antibiotics per 1 inpatient bed days was calculated on a fiscal year basis.
2, 23.4 Total amount of consumption (L) 1,5 1, 5 1.1 886.2 8. 62.3 1,24.8 967.8 53.9 37.5 1,149.8 1,224. 1,776.5 223.3 1,455. 245.2 1,387.9 6 ml 35 ml 1, ml 13. 13. 115. 78. 75. 85. 88. 7.8 Fig. 7. Volume of use of alcohol-based hand rub. This figure shows the total volume of use of ABHR for each fiscal year, according to the specifications: 6 ml (portable units for personal use), 35 ml (unit for use before entering a patient s room or at bedside), and 1, ml (unit used in the intensive care unit, laboratory, etc.). Table 1. Correlation between methicillin-resistant Staphylococcus aureus isolation rates and antimicrobial usage density or alcohol-based hand-rub use AUD vs. MRSA isolation rate in all samples (%) AUD vs. MRSA isolation rate in blood (%) Penicillins r.87 P.1 r.82 P.1 1st-generation cephalosporins r.9 P.1 r.99 P.1 2nd-generation cephalosporins r.85 P.1 r.91 P.1 3rd-generation cephalosporins r.57 P.14 r.71 P.5 4th-generation cephalosporins r.66 P.7 r.68 P.6 Oxacephems r.69 P.6 r.77 P.2 Carbapenems r.84 P.8 r.3 P.48 Fluoroquinolones r.2 P.63 r.18 P.67 Glycopeptides r.84 P.1 r.86 P.1 Alcohol-based hand rub r.77 P.3 r.89 P.1 This table shows the correlation coefficients between the methicillin-resistant Staphylococcus aureus (MRSA) isolation rates in all the samples and the antimicrobial use density (AUD) for each antibiotic class or the alcohol-based hand-rub (ABHR) use. Correlations between the MRSA isolation rates in the blood culture samples and the AUD of each antibiotic class or the ABHR use are also shown. β S. aureus β r β
β Staphylococcus aureus Staphylococcus aureus Staphylococcus aureus Staphylococcus aureus Staphylococcus aureus Staphylococcus aureus Staphylococcus aureus Staphylococcus aureus
Staphylococcus aureus Staphylococcus aureus Staphylococcus aureus Klebsiella pneumoniae Staphylococcus aureus Staphylococcus aureus Staphylococcus aureus S. aureus S. aureus r r r r r